Provider First Line Business Practice Location Address:
27 SANDY LN
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
LEWISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17044-1310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-242-7332
Provider Business Practice Location Address Fax Number:
717-242-7375
Provider Enumeration Date:
06/27/2006